scholarly journals Evolution of Experience of Care of Patients with and without Chronic Diseases following a Québec Primary Healthcare Reform

2016 ◽  
Vol 2016 ◽  
pp. 1-13
Author(s):  
Raynald Pineault ◽  
Roxane Borgès Da Silva ◽  
Sylvie Provost ◽  
Mylaine Breton ◽  
Pierre Tousignant ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Patient Experience ◽  
Primary Healthcare ◽  
The Other ◽  
New Model ◽  
Care Services ◽  
Experience Of Care ◽  
Primary Care Services ◽  
Use Of Services ◽  
Perceived Outcomes

Objectives. To assess the extent to which new primary healthcare (PHC) models implemented in two regions of Quebec have improved patient experience of care, unmet needs, and use of services for individuals with and without chronic diseases, compared with other forms of PHC practices.Methods. In 2005 and 2010, we carried out population and organization surveys. We divided PHC organizations into new model practices and other practices and followed the evolution over time of patient experience of care.Results. Patients with chronic diseases had better accessibility but worse continuity of care in the new model practices than in the other practices at both time periods. Through the reform, accessibility decreased evenly in both groups, but continuity and perceived outcomes improved more in the other practices. Use of primary care services decreased more in the new model practices. Among patients without chronic disease, accessibility decreased much less in the new models and responsiveness increased more. There was no significant change in ER attendance and hospitalization.Conclusion. The evolution of patient experience of care has been more favorable for patients without chronic diseases. These findings raise concerns about equity since the aim of the PHC reform was targeting in priority individuals with the greatest needs.

scholarly journals Chronic diseases in the paediatric population: Comorbidities and use of primary care services

2020 ◽  
Vol 93 (3) ◽  
pp. 183-193
Author(s):  
Jaime Barrio Cortes ◽  
Carmen Suárez Fernández ◽  
Mariana Bandeira de Oliveira ◽  
Cristina Muñoz Lagos ◽  
María Teresa Beca Martínez ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Diseases ◽  
Paediatric Population ◽  
Care Services ◽  
Primary Care Services

scholarly journals Using patient experience measures to evaluate the quality of medical and nursing care in the newly established PHC units (TOMYs), in Greece

2021 ◽  
Vol 14 (1) ◽  
pp. 49
Author(s):  
Olympia Konstantakopoulou ◽  
Daphne Kaitelidou ◽  
Petros Galanis ◽  
Olga Siskou ◽  
Charalambos Economou
Keyword(s):  
Health System ◽  
Patient Experience ◽  
Nursing Care ◽  
National Level ◽  
Local Health ◽  
Care Services ◽  
Primary Health ◽  
Primary Care Services ◽  
Social And Economic Development

Primary Health Care (PHC) is an integral part of both a country’s health system and of the overall social and economic development of the community. In Greece, in an effort to improve the provision of the PHC services on a national level, the Ministry of Health established the first Local Health Units (TOMYs) in December 2017. These new PHC units aimed to contribute to the provision of quality primary care services to citizens, while at the same time favoring the health system by improving the health of the population and helping to reduce health costs. Within this context, it is important for patients/PHC services’ recipients to be able to evaluate their experiences, as accumulated during their visits at these new health PHC structures. The aim of this paper was to evaluate the quality of medical and nursing care in the newly established PHC units (TOMYs) in Greece, using patient experience measures.

scholarly journals The impact of general practitioners working in or alongside emergency departments: a rapid realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024501 ◽  
Author(s):  
Alison Cooper ◽  
Freya Davies ◽  
Michelle Edwards ◽  
Pippa Anderson ◽  
Andrew Carson-Stevens ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioners ◽  
Patient Experience ◽  
Emergency Departments ◽  
Care Facility ◽  
Patient Choice ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.ConclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.PROSPERO registration numberCRD42017069741.

scholarly journals Impacts of Québec Primary Healthcare Reforms on Patients’ Experience of Care, Unmet Needs, and Use of Services

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Raynald Pineault ◽  
Roxane Borgès Da Silva ◽  
Sylvie Provost ◽  
Mylaine Breton ◽  
Pierre Tousignant ◽  
...  
Keyword(s):  
Treatment Group ◽  
Primary Healthcare ◽  
Unmet Needs ◽  
Organizational Changes ◽  
Experience Of Care ◽  
Significant Difference ◽  
Healthcare Reforms ◽  
Before And After ◽  
Use Of Services ◽  
Patients Experience

Introduction. Healthcare reforms launched in the early 2000s in Québec, Canada, involved the implementation of new forms of primary healthcare (PHC) organizations: Family Medicine Groups (FMGs) and Network Clinics (NCs). The objective of this paper is to assess how the organizational changes associated with these reforms have impact on patients’ experience of care, use of services, and unmet needs. Methods. We conducted population and organization surveys in 2005 and 2010 in two regions of the province of Québec. The design was a before-and-after natural experiment. Changes over time between new models and other practices were assessed using difference-in-differences statistical procedures. Results. Accessibility decreased between 2003 and 2010, but less so in the treatment than in the comparison group. Continuity of care generally improved, but the increase was less for patients in the treatment group. Responsiveness also increased during the period and more so in the treatment group. There was no other significant difference between the two groups. Conclusion. PHC reform in Québec has brought about major organizational changes that have translated into slight improvements in accessibility of care and responsiveness. However, the reform does not seem to have had an impact on continuity, comprehensiveness, perceived care outcomes, use of services, and unmet needs.

scholarly journals Do Gender-Predominant Primary Health Care Organizations Have an Impact on Patient Experience of Care, Use of Services, and Unmet Needs?

2017 ◽  
Vol 54 ◽  
pp. 004695801770968 ◽  
Author(s):  
Raynald Pineault ◽  
Roxane Borgès Da Silva ◽  
Sylvie Provost ◽  
Michel Fournier ◽  
Alexandre Prud’homme ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Patient Experience ◽  
Unmet Needs ◽  
Care Delivery ◽  
Care Organization ◽  
Experience Of Care ◽  
Primary Health ◽  
Use Of Services ◽  
The Impact

Physicians’ gender can have an impact on many aspects of patient experience of care. Organization processes through which the influence of gender is exerted have not been fully explored. The aim of this article is to compare primary health care (PHC) organizations in which female or male doctors are predominant regarding organization and patient characteristics, and to assess their influence on experience of care, preventive care delivery, use of services, and unmet needs. In 2010, we conducted surveys of a population stratified sample (N = 9180) and of all PHC organizations (N = 606) in 2 regions of the province of Québec, Canada. Patient and organization variables were entered sequentially into multilevel regression analyses to measure the impact of gender predominance. Female-predominant organizations had younger doctors and nurses with more expanded role; they collaborated more with other PHC practices, used more tools for prevention, and allotted more time to patient visits. However, doctors spent fewer hours a week at the practice in female-predominant organizations. Patients of these organizations reported lower accessibility. Conversely, they reported better comprehensiveness, responsiveness, counseling, and screening, but these effects were mainly attributable to doctors’ younger age. Their reporting unmet needs and emergency department attendance tended to decrease when controlling for patient and organization variables other than doctors’ age. Except for accessibility, female-predominant PHC organizations are comparable with their male counterparts. Mean age of doctors was an important confounding variable that mitigated differences, whereas other organization variables enhanced them. These findings deserve consideration to better understand and assess the impacts of the growing number of female-predominant PHC organizations on the health care system.

A randomized trial of virtual visits in a general medicine practice

2009 ◽  
Vol 15 (3) ◽  
pp. 115-117 ◽  
Author(s):  
Ronald F Dixon ◽  
James E Stahl
Keyword(s):  
Primary Care ◽  
General Medicine ◽  
The Other ◽  
Presenting Problems ◽  
Diagnostic Agreement ◽  
Face To Face ◽  
Desktop Videoconferencing ◽  
Care Services ◽  
Primary Care Services ◽  
Virtual Visits

We compared desktop videoconferencing to conventional face-to-face visits for a range of commonly presenting problems in a general practice. A total of 175 patients were recruited. Patients were randomized to one of two arms of the study. In the first arm, the patients completed a visit (virtual or face-to-face) with a physician; they then completed a second visit via the other modality with another physician. In the second arm of the study, subjects had both visits face-to-face; different physicians conducted the two face-to-face consultations. Patients found virtual visits similar to face-to-face visits on most measures, including time spent with the physician, ease of interaction and personal aspects of the interaction. Physicians were also highly satisfied with the virtual visit modality. The diagnostic agreement between physicians was 84% between face-to-face and virtual visits; it was 80% between the two face-to-face visits. The study suggests that both patients and physicians could benefit if virtual visits were used as an alternative method of accessing primary care services.

scholarly journals Strategies For Strengthening High Risk Pregnancy Care In Primary Healthcare Services

2019 ◽  
Author(s):  
Nathan Aratani ◽  
Oswaldo Yoshimi Tanaka
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Primary Healthcare ◽  
Healthcare Services ◽  
High Risk Pregnancy ◽  
Pregnancy Care ◽  
Basic Health ◽  
Care Services ◽  
Primary Care Services ◽  
Risk Pregnancy

Abstract Background: In the Brazilian Public healthcare system (The Unified Healthcare System - Sistema Único de Saúde), Primary Healthcare has expanded from implementing healthcare networks, an organization form of services with centrality to primary care services. Due to the extension and heterogeneity of Brazilian municipalities, several organization forms of primary care services existed. In the city of São Paulo they were organized by three modalities of Basic Health Units. Thus, this study aimed to evaluate the care continuity in high-risk pregnancy care in different models of the basic health units. Methods:Data analysis defined performing prenatal care in primary care even after referral to the high-risk pregnancy service as the dependent variable. The independent variables were the sociodemographic and organizational aspects of health services. Logistic regression was used as the statistical technique. Results:Care is provided in a similar way in all basic health unit models, without prioritizing pregnant women with greater vulnerabilities (under 15 years and over 35 years, with education less than 7 years). Regarding women of black or brown color, it was observed that they were more likely (OR 1.997) to have care continuity in family health units. Home visiting and knowing the community health agent proved to be tools for organizing health services which are capable of producing better care. Conclusion: Primary healthcare services in Brazil for high-risk pregnancy care are organized without considering individual vulnerabilities. The home visits and the presence of the community health agent need to be strengthened in organizing the services, as they are able to modify the process of producing healthcare.

scholarly journals Evaluation of the Integrated Primary Care Clinic Into Behavioral Care Setting

2018 ◽  
Vol 10 (11) ◽  
pp. 169
Author(s):  
Jarman Alqahtani ◽  
Daniel West
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Behavioral Health Care ◽  
Patient Survey ◽  
Care Clinic ◽  
New Model ◽  
Care Services ◽  
Primary Care Services ◽  
Short Period

OBJECTIVE: The study has aimed to explore the process, outcomes of primary care, and barriers that make the primary care access difficult for the patients. DESIGN & SETTING: The study has utilized quantitative and qualitative approach and collected data from the clinic and patients. Patient survey was conducted to ask the patients about the possible reasons, which prevent them from accessing primary care services in the past. RESULTS: The mean age of patients was 46 years, among which majority (65%) were males. The results showed that education was the significant factor in determining the health status of a specific population. The clinic was successfully integrated into the behavioral health care setting. Many patients had been enrolled in the clinic for the first time with the help of a care manager that facilitated the identification of those patients. Most commonly, transportation was the main barrier for those populations for not seeking the primary care services. Emergency department use significantly declined after the implementation of the new model that reduced the cost of health services dramatically in a short period of time i.e. 6 months. CONCLUSION: There are susceptical gaps within the fragmented care due to high rates of physical health conditions. Majority of the patients in the study sample were satisfied with the new model; therefore, the new model was termed as effective and efficient.

scholarly journals Of seint, óljóst og veikt: Hvernig og hvers vegna hugmyndin um fyrsta viðkomustaðinn í heilbrigðiskerfinu hefur misst marks

2015 ◽  
Vol 11 (2) ◽  
pp. 161-186
Author(s):  
Sigurbjörg Sigurgeirsdóttir
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Policy Implementation ◽  
Urban Areas ◽  
Theoretical Perspective ◽  
The Other ◽  
Medical Doctors ◽  
Care Services ◽  
Primary Care Services ◽  
Access To Primary Care

This research is about ideas, interests and institutions in health care in Iceland. It describes how the idea of primary care centres as the first point of patients´ contact in health care, on one hand, and the idea of patients´ freedom to choose where to seek medical care, on the other, have been the competing views shaping the system for almost fifty years. The research seeks to shed lights on why the authorities have not succeeded in making primary care become the first point of contact in health care. It aims to create a better understanding about why and how such a gap between objectives and outcomes in public policy emerges. This study draws on published and unpublished findings from the author´s earlier research on the Icelandic health care system, and interviews with medical doctors, civil servants and politicians. Theories on policy implementation are applied in order to bring out a theoretical perspective on government´s policy implementation. Furthermore, the research brings out how issues in health care reach government´s agenda and why government´s attempts at change do sometimes succeed, but most often don´t. It concludes that better access to primary care services emphasized by the early 1970s legislation was first and foremost aimed at people living outside the two main urban areas. On the other hand, the idea of patients´ first point of contact as a goal of government policy emerged too late, its aim and implementation was too ambiguous and the tool of government applied too weak.

scholarly journals Primary Healthcare Solo Practices: Homogeneous or Heterogeneous?

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Raynald Pineault ◽  
Roxane Borgès Da Silva ◽  
Sylvie Provost ◽  
Marie-Dominique Beaulieu ◽  
Antoine Boivin ◽  
...  
Keyword(s):  
Patient Experience ◽  
Primary Healthcare ◽  
Postal Survey ◽  
Homogeneous Group ◽  
Experience Of Care ◽  
Solo Practice ◽  
Source Of Care ◽  
Organizational Features ◽  
Patients Experience ◽  
Relationship Of

Introduction. Solo practices have generally been viewed as forming a homogeneous group. However, they may differ on many characteristics. The objective of this paper is to identify different forms of solo practice and to determine the extent to which they are associated with patient experience of care. Methods. Two surveys were carried out in two regions of Quebec in 2010: a telephone survey of 9180 respondents from the general population and a postal survey of 606 primary healthcare (PHC) practices. Data from the two surveys were linked through the respondent’s usual source of care. A taxonomy of solo practices was constructed (n=213), using cluster analysis techniques. Bivariate and multilevel analyses were used to determine the relationship of the taxonomy with patient experience of care. Results. Four models were derived from the taxonomy. Practices in the “resourceful networked” model contrast with those of the “resourceless isolated” model to the extent that the experience of care reported by their patients is more favorable. Conclusion. Solo practice is not a homogeneous group. The four models identified have different organizational features and their patients’ experience of care also differs. Some models seem to offer a better organizational potential in the context of current reforms.

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